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Strengthen the Evidence for Maternal and Child Health Programs

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Displaying records 1 through 20 (37 total).

Altimier L, Straub S, Narendran V. Improving outcomes by reducing elective deliveries before 39 weeks of gestation: a community hospital's journey. Newborn & Infant Nursing Reviews. 2011;11(2):50-55. doi:10.1053/j.nainr.2011.04.011

Link: https://www.sciencedirect.com/science/article/pii/S1527336911000559

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Chart Audit and Feedback, Guideline Change and Implementation, Organizational Changes, Peer Review, Quality Improvement

Intervention Results:

Rate of CS among electively induced women at the level II hospital decreased from 37.4% (2005) to 31.5% (2006) to 25% (2007). From 2005 to 2006, one year after hospital review was launched, there was a 5.9% decrease in CS (p<0.05)2. From 2006 to 2007, two years after hospital review was launched and supplemental changes to elective induction policies and practices were made, there was a 6.5% decrease in CS (p<0.05)2.

Bergstrom M, Kieler H, Waldenstrom U. Psychoprophylaxis during labor: associations with labor-related outcomes and experience of childbirth. Acta Obstet Gynecol Scand. 2010;89(6):794-800.

Link: https://www.ncbi.nlm.nih.gov/pubmed/20225989

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): Psychoprophylaxis, PATIENT/CONSUMER

Intervention Results:

Use of psychoprophylaxis during labor was associated with a lower risk of emergency cesarean section (adjusted odds ratio (OR) 0.57; 95% confidence interval (CI) 0.37-0.88), but an increased risk of augmentation of labor (adjusted OR 1.68; 95% CI 1.23-2.28). No statistical differences were found in length of labor (adjusted OR 1.32; 95% CI 0.95-1.83), Apgar score < 7 at five minutes (adjusted OR 0.82; 95% CI 0.33-2.01), epidural analgesia (adjusted OR 1.13; 95% CI 0.84-1.53) or fearful childbirth experience (adjusted OR 1.04; 95% CI 0.62-1.74).

Blomberg M. Avoiding the first cesarean section-results of structured organizational and cultural changes. Acta Obstet Gynecol Scand. 2016;95(5):580-586. doi:10.1111/aogs.12872

Link: https://www.ncbi.nlm.nih.gov/pubmed/26870916

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): Midwifery, PROVIDER/PRACTICE, HOSPITAL, Chart Audit and Feedback, Organizational Changes, Quality Improvement, POPULATION-BASED SYSTEMS, Community — Outreach, Outreach, COMMUNITY, COMMUNITY

Intervention Results:

The CS rate in nulliparous women at term with spontaneous onset of labor decreased from 10% in 2006 to 3% in 2015. During the same period the overall CS rate dropped from 20% to 11%. The prevalence of children born at the unit with umbilical cord pH <7 and Apgar score <4 at 5 min were the same over the years studied. At present, 95.2% of women delivering at our unit are satisfied with their delivery experience.

Cammu H, Eeckhout E. A randomised controlled trial of early versus delayed use of amniotomy and oxytocin infusion in nulliparous labour. Br J Obstet Gynaecol. 1996;103(4):313- 318.

Link: https://www.ncbi.nlm.nih.gov/pubmed/8605126

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): Active Management of Labor, PROVIDER/PRACTICE

Intervention Results:

Maternal characteristics were comparable in both groups. Amniotomy was more often performed (91% versus 57%, P <0.01) and oxytocin more often used (53% versus 27%, P < 0.01) in the active management group. The first stage of labour, however, was only shortened by half an hour in the active management group (254 min versus 283 min, P = 0.087). Caesarean section rate (3.9% versus 2.6%), spontaneous vaginal delivery rate (78% versus 79%) and neonatal outcome were not significantly different between groups.

Campbell DA, Lake MF, Falk M, Backstrand JR. A randomized control trial of continuous support in labor by a lay doula. J Obstet Gynecol Neonatal Nurs. 2006;35(4):456-464. doi:10.1111/j.1552-6909.2006.00067.x

Link: https://pubmed.ncbi.nlm.nih.gov/16881989/

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): Labor Support, PROVIDER/PRACTICE

Intervention Results:

Significantly shorter length of labor in the doula group, greater cervical dilation at the time of epidural anesthesia, and higher Apgar scores at both 1 and 5 minutes. Differences did not reach statistical significance in type of analgesia/anesthesia or cesarean delivery despite a trend toward lower cesarean delivery rates in the doula group.

Davey MA, McLachlan HL, Forster D, Flood M. Influence of timing of admission in labour and management of labour on method of birth: results from a randomised controlled trial of caseload midwifery (COSMOS trial). Midwifery. 2013;29(12):1297-1302.

Link: https://www.ncbi.nlm.nih.gov/pubmed/23890679

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Continuity of Care (Caseload)

Intervention Results:

Nulliparous women randomised to standard care were more likely to have labour augmented than those having caseload care (54.2% and 45.5% respectively, p=0.008), but were no more likely to use epidural analgesia. They were admitted earlier in labour, spending 1.1 hours longer than those in the caseload arm in hospital before the birth (p=0.003). Parous women allocated to standard care were more likely than those in the caseload arm to use epidural analgesia (10.0% and 5.3% respectively, p=0.047), but were no more likely to have labour augmented. They were also admitted earlier in labour, with a median cervical dilatation of 4 cm compared with 5 cm in the caseload arm (p=0.012). Pooling the two randomised groups of nulliparous women, and after adjusting for randomised group, maternal age and maternal body mass index, early admission to hospital was strongly associated with caesarean section. Admission before the cervix was 5 cm dilated increased the odds 2.4-fold (95%CI 1.4, 4.0; p=0.001). Augmentation of labour and use of epidural analgesia were each strongly associated with caesarean section (adjusted odds ratios 3.10 (95%CI 2.1, 4.5) and 5.77 (95%CI 4.0, 8.4) respectively.

Davis LG, Riedmann GL, Sapiro M, Minogue JP, Kazer, RR. Cesarean section rates in low- risk private patients managed by certified nurse-midwives and obstetricians. J Nurse Midwifery. 1994;39(2):91-97.

Link: https://www.ncbi.nlm.nih.gov/pubmed/8027851

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Midwifery

Intervention Results:

Nurse-midwife-managed patients had a significantly lower rate of cesarean section (8.5% versus 12.9%; P < .005) and operative vaginal delivery (5.3% versus 17%, P = .0001) than the physician-managed patients. Epidural anesthesia and oxytocin for induction and augmentation were used significantly more frequently in the physician-managed patients. Both interventions were associated with an increased rate of cesarean section. Fetal outcomes in the two groups were not statistically different.

Dickinson JE, Paech MJ, McDonald SJ, Evans SF. The impact of intrapartum analgesia on labour and delivery outcomes in nulliparous women. Aust N Z J Obstet Gynaecol. 2002;42(1): 59-66.

Link: https://www.ncbi.nlm.nih.gov/pubmed/11926643

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Continuity of Care (Caseload), Epidural Analgesia, Midwifery

Intervention Results:

Rate of CS lower in CMS group vs. epidural group (14.2% vs. 17.2%; p>0.05)

Eide BI, Nilsen AB, Rasmussen S. Births in two different delivery units in the same clinic--a prospective study of healthy primiparous women. BMC Pregnancy Childbirth. 2009;9:25. doi:10.1186/1471-2393-9-25

Link: https://www.ncbi.nlm.nih.gov/pubmed/19545412

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Midwifery

Intervention Results:

Emergency caesarean and instrumental delivery rates in women who were admitted to the midwife-led and conventional birth wards were statistically non-different, but more women admitted to the conventional birth ward had episiotomy. More women in the conventional delivery ward received epidural analgesia, pudental nerve block and nitrous oxide, while more women in the midwife-led ward received opiates and non-pharmacological pain relief.

Eriksen, LM, Nohr EA, Kjaergaard H. Mode of delivery after epidural analgesia in a cohort of low-risk nulliparas. Birth. 2011;38(4):317-326. doi:10.1111/j.1523-536X.2011.00486.x

Link: https://www.ncbi.nlm.nih.gov/pubmed/22112332

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Epidural Analgesia

Intervention Results:

Of the total cohort, 21.6 percent required epidural analgesia, 8.7 percent had emergency cesarean section, and 14.9 percent had vacuum extraction. Women with epidural analgesia had a higher risk of emergency cesarean section (adjusted OR: 5.8; 95% CI: 4.1-8.1), and vacuum extraction (adjusted OR: 1.7; 95% CI: 1.3-2.2). In a subgroup of the cohort with a very low overall risk of cesarean section, 3.4 percent had emergency cesarean section and an increased risk of emergency cesarean section was also found in this group (adjusted OR: 3.5; 95% CI: 1.5-8.2).

Eriksson SL, Olausson PO, Olofsson C. Use of epidural analgesia and its relation to caesarean and instrumental deliveries-a population--based study of 94,217 primiparae. Eur J Obstet Gynecol Reprod Biol. 2006;128(1-2):270-275. doi:10.1016/j.ejogrb.2005.10.030

Link: https://www.ncbi.nlm.nih.gov/pubmed/16343733

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): Epidural Analgesia, PROVIDER/PRACTICE

Intervention Results:

There was no clear association between frequency of epidural block and caesarean section and instrumental delivery, respectively. Delivery units with the lowest (20-29%) and the highest (60-64%) relative frequencies of epidural block had the lowest proportion of caesarean section (9.1%). For the other groups the proportion varied between 10.3 and 10.6%. Instrumental deliveries were most common, 18.8%, in delivery units with 50-59% frequency of epidural block use. The lowest incidence (14.1%) was in units using epidurals in 30-39% of cases. In the other groups (20-29, 40-49 and 60-64%) the proportion varied between 15.3 and 15.7%.

Fenwick J, Toohill J, Gamble J, et al. Effects of a midwife psycho-education intervention to reduce childbirth fear on women's birth outcomes and postpartum psychological wellbeing. BMC Pregnancy Childbirth. 2015;15:284. doi:10.1186/s12884-015-0721-y

Link: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-015-0721-y

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Intensive Therapy

Intervention Results:

Compared to controls the intervention group had a clinically meaningful but not statistically significant reduction in overall caesarean section (34 % vs 42 %, p = 0.27) and emergency CS rates (18 % vs 25 %, p = 0.23). Fewer women in the intervention group preferred caesarean section for a future pregnancy (18 % vs 30 %, p = 0.04). All other obstetric variables remained similar. There were no differences in postnatal depression symptoms scores, parenting confidence, or satisfaction with maternity care between groups, but a lower incidence of flashbacks about their birth in the intervention group compared to controls (14 % vs 26 %, p = 0.05). Postnatally women who received psycho-education reported that the ‘decision aid’ helped reduce their fear (53 % vs 37 %, p = 0.02).

Frigoletto FD, Lieberman E, Lang JM, et al. A clinical trial of active management of labor. N Engl J Med. 1995;333(12):745-750. doi:10.1056/nejm199509213331201

Link: https://www.ncbi.nlm.nih.gov/pubmed/7643880

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Childbirth Education Classes, PROVIDER/PRACTICE, Active Management of Labor, Labor Support, Midwifery

Intervention Results:

Rate of CS among protocol-eligible women lower in AMOL group vs. control group (10.9% vs. 11.5%; p>0.05) after adjustment for epidural use and adoption of final protocol (three hours for second stage of labor with epidural); (OR=0.9, 95% CI: 0.4–1.9)

Gagnon AJ, Waghorn K. One-to-one nurse labor support of nulliparous women stimulated with oxytocin. J Obstet Gynecol Neonatal Nurs. 1999;28(4):371-376.

Link: https://www.ncbi.nlm.nih.gov/pubmed/10438081

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): Labor Support, PROVIDER/PRACTICE

Intervention Results:

A beneficial trend because of one-to-one nurse support, with a 56% reduction in risk of total cesarean deliveries [RR of experimental vs. control = 0.44 (95% confidence interval = 0.19 to 1.01)].

Gimovsky AC, Berghella V. Randomized controlled trial of prolonged second stage: extending the time limit vs usual guidelines. Am J Obstet Gynecol. 2016;214(3):361.e1-6.

Link: https://www.ncbi.nlm.nih.gov/pubmed/26928148

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Prolonged Second Stage of Labor

Intervention Results:

The incidence of cesarean delivery was 19.5% (n = 8/41 deliveries) in the extended labor group and 43.2% (n = 16/37 deliveries) in the usual labor group (relative risk, 0.45; 95% confidence interval, 0.22-0.93). The number needed-to-treat to prevent 1 cesarean delivery was 4.2. There were no statistically significant differences in maternal or neonatal morbidity outcomes.

Gottvall K, Waldenström U, Tingstig C, Grunewald C. In-hospital birth center with the same medical guidelines as standard care: a comparative study of obstetric interventions and outcomes. Birth. 2011;38(2):120-128.

Link: https://www.ncbi.nlm.nih.gov/pubmed/21599734

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Continuity of Care (Caseload), Labor Support, State — Place of Birth, POPULATION-BASED SYSTEMS, STATE, Place of Birth

Intervention Results:

The modified birth center group included fewer emergency cesarean sections (primiparas: OR: 0.69, 95% CI: 0.58-0.83; multiparas: OR: 0.34, 95% CI: 0.23-0.51), and in multiparas the vacuum extraction rate was reduced (OR: 0.42, 95% CI: 0.26-0.67). In addition, epidural analgesia was used less frequently (primiparas: OR: 0.47, 95% CI: 0.41-0.53; multiparas: OR: 0.25, 95% CI: 0.20-0.32). Fetal distress was less frequently diagnosed in the modified birth center group (primiparas: OR: 0.72, 95% CI: 0.59-0.87; multiparas: OR: 0.45, 95% CI: 0.29-0.69), but no statistically significant differences were found in neonatal hypoxia, low Apgar score less than 7 at 5 minutes, or proportion of perinatal deaths (OR: 0.40, 95% CI: 0.14-1.13). Anal sphincter tears were reduced (primiparas: OR: 0.73, 95% CI: 0.55-0.98; multiparas: OR: 0.41, 95% CI: 0.20-0.83).

Harris SJ, Janssen PA, Saxell L, Carty EA, MacRae GS, Petersen KL. Effect of a collaborative interdisciplinary maternity care program on perinatal outcomes. CMAJ. 2012;184(17):1885- 1892. doi:10.1503/cmaj.111753

Link: https://www.ncbi.nlm.nih.gov/pubmed/22966055

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Labor Support, POPULATION-BASED SYSTEMS, State — Place of Birth, STATE, Place of Birth

Intervention Results:

Compared with women receiving standard care, those in the birth program were more likely to be delivered by a midwife (41.9% v. 7.4%, p < 0.001) instead of an obstetrician (35.5% v. 69.6%, p < 0.001). The program participants were less likely than the matched controls to undergo cesarean delivery (relative risk [RR] 0.76, 95% confidence interval [CI] 0.68-0.84) and, among those with a previous cesarean delivery, more likely to plan a vaginal birth (RR 3.22, 95% CI 2.25-4.62). Length of stay in hospital was shorter in the program group for both the mothers (mean ± standard deviation 50.6 ± 47.1 v. 72.7 ± 66.7 h, p < 0.001) and the newborns (47.5 ± 92.6 v. 70.6 ± 126.7 h, p < 0.001). Women in the birth program were more likely than the matched controls to be breastfeeding exclusively at discharge (RR 2.10, 95% CI 1.85-2.39).

Hodnett ED, Lowe NK, Hannah ME, et al. Effectiveness of nurses as providers of birth labor support in North American hospitals: a randomized controlled trial. JAMA. 2002;288(11):1373- 1381.

Link: https://www.ncbi.nlm.nih.gov/pubmed/12234231

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Labor Support

Intervention Results:

Compared with women receiving standard care, those in the birth program were more likely to be delivered by a midwife (41.9% v. 7.4%, p < 0.001) instead of an obstetrician (35.5% v. 69.6%, p < 0.001). The program participants were less likely than the matched controls to undergo cesarean delivery (relative risk [RR] 0.76, 95% confidence interval [CI] 0.68-0.84) and, among those with a previous cesarean delivery, more likely to plan a vaginal birth (RR 3.22, 95% CI 2.25-4.62). Length of stay in hospital was shorter in the program group for both the mothers (mean ± standard deviation 50.6 ± 47.1 v. 72.7 ± 66.7 h, p < 0.001) and the newborns (47.5 ± 92.6 v. 70.6 ± 126.7 h, p < 0.001). Women in the birth program were more likely than the matched controls to be breastfeeding exclusively at discharge (RR 2.10, 95% CI 1.85-2.39).

Hueston WJ, Rudy M. A comparison of labor and delivery management between nurse midwives and family physicians. J Fam Pract.1993;37(5):449-454.

Link: https://www.ncbi.nlm.nih.gov/pubmed/8228856

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): Midwifery, PROVIDER/PRACTICE

Intervention Results:

Few differences were noted between nurse midwives and family physicians in the management of labor or delivery. The only consistent finding was that family physicians were more likely than midwives to use an episiotomy for delivery (40% vs 30% in primiparous women, P = .02; and 20% vs 10% in multiparous women, P = .007). Despite seemingly similar management styles, primiparous women managed by family physicians were more likely to undergo cesarean section (14% vs 8%, P = .05) resulting from the diagnosis of dystocia. When practice specialty was included in a logistic regression model with parity and the number of preexisting risk factors, the effect of specialty on cesarean sections remained significant with a relative risk of 2.79 for cesarean section if patients had their labor managed by a family physician (P < .001).

Iglesias S., Burn R, Saunders LD. Reducing the cesarean section rate in a rural community hospital. CMAJ. 1991;145(11):1459-1464.

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1336036/

NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Guideline Change and Implementation, Organizational Changes, Quality Improvement, POPULATION-BASED SYSTEMS, NATIONAL, Policy/Guideline (National)

Intervention Results:

The overall cesarean section rate decreased from 23% in 1985 to 13% in 1989 (p = 0.001). Among the nulliparous women the rate decreased from 23% to 12%, but the difference was insignificant (p = 0.069); this decrease was due to a drop in the number of dystocia-related cesarean sections. The rate among vaginal birth after cesarean section (VBAC) -eligible multiparous women decreased from 93% to 36% (p less than 0.001) because of an increased acceptance of VBAC by the patients and the physicians. The rate among multiparous women ineligible for VBAC was virtually unchanged.
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This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.